A team of researchers at Stanford University in collaboration with the University of Oxford is making a surgical procedure called craniectomy after brain swelling much safer.

A cortical contusion, or a brain bruise, increases the amount of fluid within the skull, causing brain swelling, and increasing intracranial pressure (ICP). The goal of neurosurgery after a severe brain injury is often to relieve pressure.

The procedures may include removing a portion of the skull, by creating a “brain flap.” When this is done, it allows room for the brain to expand. The procedure is called either a craniotomy or a craniectomy. For more information on craniotomy, see http://tbilaw.com/craniotomy.html.

The difference between a craniotomy and craniectomy is that, in a craniectomy, the surgeon does not return the bone flap after surgery and can be left off for months. Complications from a craniotomy or craniectomy can include seizures and bacterial meningitis. Pain can also be a factor.

In one study, researchers found that craniectomy saves lives, but creates other complications. Despite lower mortality, it increased the likelihood of being in a vegetative state and having lower severe and upper severe disability.  

When the brain bulges out of the hole created in surgery, the axons tend to stretch and break. The researchers created a simulator that can tell surgeons where the optimal place to cut a hole is and how big the hole should be. In creating this devices, they studied medical scans that displayed the amount of swelling for different types of brain injuries.

After that, they produced mathematical estimates predicting how an injury would affect various parts of the brain. Then, they ran different scenarios through the simulator and found serious damage would occur if axons expand near or above 30 percent. The device displays the most affected parts of the brain in red, mild damage in green and safe parts in blue. Their device would give surgeons a very visual tool to decide where the best place to make the cut is.

You may view a video about their tool here: https://www.youtube.com/watch?v=MCMz02Hq9dI.

Gordon Johnson

Attorney Gordon Johnson is one of the nations leading brain injury advocates. He is Past-Chair of the TBILG, a national group of more than 150 brain injury advocates. He has spoken at numerous brain injury seminars and is the author of some of the most read brain injury web pages on the internet.

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